Outline

Introduction: Obstruction at the hepatic duct confluence is generally due to hilar cholangiocarcinoma (HCCA). Preoperative diagnosis is hardly rule out the alternative etiology, namely Klatskin mimicking lesions. The aim of this study was to find the difference of the clinical data between Klatskin mimicking lesion and HCCA with focus on the operation methods, histology and outcome.

Materials and methods: All patients with hilar obstruction presumed to represent HCCA were included (2004-2011). Beside the demographic data, the operation, histology and outcome was retrospectively studied.

Results: A total of 78 patients were included in the study, with HCCA being the most common diagnosis (65 patients [78.2%], group I). Alternative diagnoses other than HCCA were encountered in 14 patients with (17.9%, group II) and 3 patients with unknown etiology (no convincing histology could be taken due to co-morbidity). Tumor resection with the intent-to-cure was carried out in 48 patients from the group I as well as in all patients from the group II. Bile duct resection combined with partial hepatectomy was performed in 42 patients in group I (87.5%) and 9 patients in group II (62.3%) while bile duct resection without partial hepatectomy was performed in 4 patients in group I (12.5%) and 5 patients in group II (37.7%). 7 portal vein resection (14.6%) was necessary in group I whereas none was carried out in group II. The 30-day mortality was 6.3% (n=3) in group I and 7.1% (n=1) in group II. The histology for the Klatskin mimicking lesion was autoimmune cholangitis (n=5), focal inflammation related to post-cholecystectomy (n=4), intraductal papillary mucinous neoplasm of the bile duct (n=3), Caroli disease (n=1), biliary cystadenoma (n=1).

Conclusion: Non-malignancy lesion was found in 21.9% of the patients undergoing intent-to-cure tumor resection due to suspicion of HCCA. In this group, less aggressive operation (such as combined partial hepatectomy as well as portal vein resection) was carried out. If diagnosis could be ensured preoperatively, 4 partial hepatectomies in this group can be avoided.